[Alerts system associated with computerized physician order entry: analysis and identification of improvement points]. / Sistema de alertas asociado a prescripción electrónica asistida: análisis e identificación de puntos de mejora.

OBJECTIVE: To make a quantitative analysis of the alerts associated with a computerized physician order entry system and identify opportunities to improve the system. METHOD: A retrospective observational study in a general hospital with 750 beds, 500 of which have a computerized physician order entry system installed. The frequency per type and medication of 525,691 alerts produced for a year in the prescription of drug treatments to 15,466 patients was analysed, entering these on a database. The system includes three categories of alert relating to the drug, the characteristics of the patient and the hospital medicine policy. By means of a failure mode and effects analysis, opportunities for improving the system were identified and corrective measures were suggested. RESULTS: It has been observed that from the total of 1,084 drugs, 20 of them produce 34% of alerts. The ten most frequently active ingredients involved are: potassium chloride, acenocumarol, imipenem, lorazepam, diazepam, mycophenolate, enoxaparin, tacrolimus, calcium carbonate and cyclosporine. The most frequent alerts generated during electronic prescription are associated with duplicated therapy (35.4%), renal failure (27.6%) and risk due to advanced age (17.2%), with these groups accounting for 80.2% of the total. The excess of alerts and information provided by the alerts were identified as priority improvement points. CONCLUSIONS: The system produced excessive alerts which led to the risk of them being ignored and reducing the capacity to prevent adverse drug events. Modifications are required for the design of the alert system, which also needs to be continuously updated.

Sistema de alertas asociado a prescripción electrónica asistida: análisis e identificación de puntos de mejora / No disponible

Objetivo: Realizar un análisis cuantitativo de alertas asociadasa un sistema de prescripción electrónica asistida e identificar oportunidadesde mejora de dicho sistema.Método: Estudio observacional retrospectivo en un hospitalgeneral con 750 camas, de las cuales 500 disponen de prescripciónelectrónica asistida. Se analizó la frecuencia por tipo y medicamentode 525.691 alertas generadas durante un año en laprescripción de los tratamientos farmacológicos de 15.466pacientes, trasfiriéndose para ello a una base de datos. El sistemacontempla tres categorías de alertas relacionadas con el medicamento,las características del paciente y la política de medicamentosdel hospital. Mediante análisis de modos de fallos y efectos seidentificaron oportunidades de mejora del sistema y se propusieronacciones correctoras.Resultados: Se observó que 20 medicamentos del total de1.084 generaron el 34% de las alertas, siendo los diez principiosactivos más frecuentemente implicados: cloruro potásico, acenocumarol,imipenem, lorazepam, diazepam, micofenolato, enoxaparina,tacrolimus, carbonato cálcico y ciclosporina. Las alertas más frecuentesgeneradas durante la prescripción electrónica se asociaroncon duplicidad terapéutica (35,4%), insuficiencia renal (27,6%) yriesgo por geriatría (17,2%), constituyendo estos grupos el 80,2%del total. Se identificaron como puntos de mejora prioritarios lasobrecarga de alertas y la información facilitada por las alertas.Conclusiones: El sistema genera excesivas alertas con el consiguienteriesgo de ser ignoradas y de disminuir su capacidad parala prevención de acontecimientos adversos a medicamentos. Serequieren modificaciones en el diseño del sistema de alertas, asícomo la actualización continua de las mismas

Objective: To make a quantitative analysis of the alerts associatedwith a computerized physician order entry system and identifyopportunities to improve the system.Method: A retrospective observational study in a general hospitalwith 750 beds, 500 of which have a computerized physicianorder entry system installed. The frequency per type and medicationof 525,691 alerts produced for a year in the prescription ofdrug treatments to 15,466 patients was analysed, entering theseon a database. The system includes three categories of alert relatingto the drug, the characteristics of the patient and the hospitalmedicine policy. By means of a failure mode and effects analysis,opportunities for improving the system were identified and correctivemeasures were suggested.Results: It has been observed that from the total of 1,084drugs, 20 of them produce 34% of alerts. The ten most frequentlyactive ingredients involved are: potassium chloride,acenocumarol, imipenem, lorazepam, diazepam, mycophenolate,enoxaparin, tacrolimus, calcium carbonate and cyclosporine. Themost frequent alerts generated during electronic prescription areassociated with duplicated therapy (35.4%), renal failure (27.6%)and risk due to advanced age (17.2%), with these groups accountingfor 80.2% of the total. The excess of alerts and informationprovided by the alerts were identified as priority improvementpoints.Conclusions: The system produced excessive alerts which ledto the risk of them being ignored and reducing the capacity toprevent adverse drug events. Modifications are required for thedesign of the alert system, which also needs to be continuouslyupdated

[Pharmaceutical care self-assessment process for hospitalized patients through the Valor program]. / Autoevaluación del proceso de atención farmacéutica en pacientes hospitalizados a través del programa Valor.

OBJECTIVE: To assess the quality of pharmaceutical care for inpatients using qualitative criteria as established in the Valor program. METHOD: Evaluation study through 43 explicit structural, process, and outcome criteria within the Valor program, in which pharmacists in the Unit Dose Functional Unit may assess themselves along a compliance scale from 0 to 100%. This Unit provides daily individualized pharmaceutical care to 550 patients in an adult general and surgery hospital. Mean scores per pharmacist and item are estimated for the 2003-2005 period. RESULTS: Mean compliance assessments for all 14 interannual "structural items" were 53, 57, and 64%; those for all 13 "process items" were 52, 51, and 46%; and those for all 15 "outcome items" were 18, 28, and 26%. A variability of 20% was documented for structure and process evaluations, and of 50% for outcome assessments. CONCLUSIONS: Every autoevaluation raises to the equipment the necessity to establish improvements and to enhance communication, and the application of standardized procedures in the pharmaceutical care process.

Autoevaluación del proceso de atención farmacéutica en pacientes hospitalizados a través del programa Valor / No disponible

Objetivo: Evaluar la calidad en la atención farmacéutica alpaciente hospitalizado a través de criterios cualitativos establecidosen el programa Valor®.Método: Estudio de evaluación a través de 43 criterios explícitosestructurales, de proceso y de resultado incluidos en el programaValor® que valoran los propios farmacéuticos de la unidad funcionalde dosis unitarias, en una escala de cumplimiento del 0 a100%. Dicha unidad proporciona atención farmacéutica individualizadadiariamente a 550 pacientes, pertenecientes a un hospitalgeneral de patología y cirugía del adulto. Se calculan las mediasde las puntuaciones por farmacéutico y por elemento en el periodo2003-2005.Resultados: Las valoraciones medias de cumplimiento paralos catorce elementos estructurales interanuales fueron de 53, 57y 64%; los trece de proceso 52, 51 y 46%; y los quince de resultado18, 28 y 26%. Se evidencia una variabilidad entorno al 20%para las evaluaciones de estructura y proceso y del 50% en las deresultado.Conclusiones: Cada autoevaluación plantea al equipo farmacéuticoestablecer mejoras y potenciar la comunicación y la aplicaciónde procedimientos normalizados para el proceso de atenciónfarmacéutica

Objective: To assess the quality of pharmaceutical care forinpatients using qualitative criteria as established in the Valor®program.Method: Evaluation study through 43 explicit structural,process, and outcome criteria within the Valor® program, in whichpharmacists in the Unit Dose Functional Unit may assess themselvesalong a compliance scale from 0 to 100%. This Unit providesdaily individualized pharmaceutical care to 550 patients inan adult general and surgery hospital. Mean scores per pharmacistand item are estimated for the 2003-2005 period.Results: Mean compliance assessments for all 14 interannual“structural items” were 53, 57, and 64%; those for all 13“process items” were 52, 51, and 46%; and those for all 15 “outcomeitems” were 18, 28, and 26%. A variability of 20% wasdocumented for structure and process evaluations, and of 50% foroutcome assessments.Conclusions: Every autoevaluation raises to the equipmentthe necessity to establish improvements and to enhace communication,and the application of standardized procedures in thepharmaceutical care process

[Therapeutic interchange of drugs not included in the hospitals pharmacotherapeutic guide: a quality program]. / Programa de calidad aplicado a la sustitución de medicamentos no incluidos en la Guía Farmacoterapéutica del hospital.

BACKGROUND: Standardised substitution of those drugs not included in the hospitals formulary constitutes one of several methods used to improve therapeutic efficiency, due to reduction of variability in pharmaceutical practice and prevention of potential medication errors. OBJECTIVES: To evaluate quality of drug substitution procedures in those drugs not included in the hospital's formulary. METHODS: Assessment study in a surgical hospital with 314 beds, using structural, process and outcome criteria from 1998 to 2002. RESULTS: Compliance degree for structure, process and outcome criteria were 100, 89 and 35%, respectively, while the established standards were 100%. Prevalence values for patients with substituted medication, increased from 2.9 (95%CI, 2.4-3.6) in 1998 to 11.1% (95%CI, 10.2-12.1) in 2002. Non-substituted drugs annual cost decreased from 20,199 in 1998 to 12,356 Euro in 2002. Drug substitution made by the pharmacist had an acceptance degree of 82.5%. No interchange errors were found in 126 replaced drugs. CONCLUSIONS: The development of quality programs to improve drug prescription adherence to the hospitals formulary, specially those that promote therapeutic interchange under the Pharmacy Committee guidance, are helpful strategies to make a proficient management of patients pharmacotherapy.